Life is an unpredictable journey. It can take sharp, fatal turn at moments, which are capable of leaving one physically, mentally, emotionally and financially bruised.

Many of us ignore buying a personal Health Insurance plan (Mediclaim). Many of us also think that the mediclaim coverage provided by the employer is sufficient enough to cover any unforeseen medical expenses.

In my experience, the average medical cover opted (personal health insurance) or provided by an employer (group mediclaim)is generally in the range of Rs 3 Lakh to Rs 5 Lakh. Do you really think that this coverage is sufficient? What if the claim amount is more than the coverage amount? Can you afford to pay for the medical expenses out of your pocket? Do you agree that medical expenses are increasing at a very fast rate every year?

But, we are also aware of the fact that the premiums of health insurance plans are increasing every year. For some of us, the premiums are unaffordable. Also, it is not practically possible for everyone to increase the premium of their existing plan, or buy another mediclaim policy.

So, what are the available options? How to get higher coverage at affordable premium rates? How to deal with the inflating costs of medical treatment?

Have you heard of Top up Health Insurance plans / Super Top up Medical Insurance plans?

In this post, let us understand– What are Top up Health Insurance plans? What are Super Top up Health Insurance Plans? How does Top Up medical insurance work? How does Super Top up plan work? Which one should you buy, a Top up plan (or) a Super top up plan? Frequently Asked Questions (FAQs) on Top up Health Insurance Plans / Super Top up Health Insurance Plans.

What are Top up Health Insurance Plans?

Top up health insurance plans are a unique type of health cover policies that offer you (insured) an additional coverage, which is beyond the “threshold limit” (or) the maximum limit of the existing health insurance policies.

For example – Let’s say you have an Employer’s Mediclaim policy for Rs 3 Lakh and also a Top up Health cover for Rs 10 Lakh with the threshold limit (deductible) of Rs 3 Lakh.

If there is a claim for Rs 5 Lakh, your mediclaim policy (employer’s) will pay Rs 3 Lakh and the remaining claim amount of Rs 2 Lakh will be covered by your Top up policy.

So, such Top up health insurance policies come handy when the threshold of the existing health cover is already used or exhausted and there are some medical costs left to deal with, which would otherwise exert pressure on your financial savings. (To buy a Top up plan, it is not mandatory to have an existing health insurance policy. The threshold limit is the mandatory deductible, which can be borne by you or by your existing health insurance policy i.e., your company’s or personal regular health insurance policy)

How does Top Up Health insurance plan work?

Top up plans work on ‘per hospitalization’ basis. A Top up plan will pay you, if your claim amount for a single hospitalization is above the threshold limit.

Example– Mr Kejriwal has a personal Health Insurance policy of Rs 3 Lakh and also has a Top up health cover of Rs 10 Lakh sum assured, with the threshold limit of Rs 3 Lakh.

Scenario 1 – If there is a single claim of Rs 2 Lakh in a year, his regular policy will pay Rs 2 Lakh.

Scenario 2 – If there is a single claim of Rs 5 Lakh in a year, his regular policy will pay RS 3 Lakh and top up plan will pay the remaining Rs 2 Lakh.

Scenario 3 – If there is a single claim of Rs 10 Lakh in a year, his regular policy will pay Rs 3 Lakh and the remaining claim amount of Rs 7 lakh will be paid by the Top up plan.

Scenario 4 – If there are two claims in a year, one for Rs 3 Lakh (Claim 1) & another for Rs 2.5 Lakhs (claim 2), regular policy will pay the claim 1 amount (Rs 3 Lakh) and the total coverage is exhausted, the claim 2 amount (Rs 2.5 Lakh) is not covered by regular as well as the top up plan. (Though he has Rs 10 lakh as a top up cover, it is not applicable for 2nd claim as the threshold limit is Rs 3 Lakh. Top up cover will pay only if the bill amount is more than Rs 3 Lakh)

What are Super Top up Health Insurance Plans?

We are now clear that the Top up plans work on ‘per claim’ or ‘per single hospitalization’basis, they are beneficial as long as the single claim amount is above the threshold limit.

In the above scenario 4, though Mr Kejriwal has Rs 10 Lakh Top up cover, his claim amount (claim 2) will not be paid. Super Top plans will be useful in these types of scenarios (multiple claims).

Example – Mr Kejriwal has a personal Health Insurance policy of Rs 3 Lakh and also has a Super Top up health cover of Rs 10 Lakh sum assured (total coverage Rs 13 Lakh), with the threshold limit of Rs 3 Lakh.

Scenario 5– If there is a single claim of Rs 2 Lakh in a year, his regular policy will pay Rs 2 Lakh.

Scenario 6 – If there is a single claim of Rs 5 Lakh in a year, his regular policy will pay RS 3 Lakh and super top up plan will pay the remaining Rs 2 Lakh.

Scenario 7 – If there is a single claim of Rs 10 Lakh in a year, his regular policy will pay Rs 3 Lakh and the remaining claim amount of Rs 7 lakh will be paid by the Super Top up medical insurance plan.

Scenario 8 – If there are two claims in a year, one for Rs 3 Lakh (Claim 1) & another for Rs 2.5 Lakhs (claim 2), regular policy will pay the claim 1 amount (Rs 3 Lakh) and the total coverage is exhausted, the claim 2 amount (Rs 2.5 Lakh) will be paid by his super top up plan (though the claim 2 amount is less than the threshold limit)

Scenario 9– If there are two claims in a year, one for Rs 5 Lakh (claim 1) & another for Rs 6 Lakh (claim 2), regular policy will pay upto Rs 3 Lakh (claim 1) & super top up plain will pay the remaining Rs 2 Lakh amount (a portion of claim 1). The entire claim 2 amount (Rs 6 Lakh) will be paid by Super top up plan, as the regular policy coverage is exhausted.

So, it is now clear that Super Top up plans consider ‘the total of all the bills’ in a given year. Super Top up plans cover ‘multiple’ hospitalizations and they look at the aggregate claim. This means they put together several cases of hospitalization to calculate the deductible limit (threshold limit).

FAQs & Important points about Top up / Super Top up Health Insurance plans ;

Is it necessary to have a regular health insurance plan? – It is not mandatory to have an existing regular or group mediclaim to buy a top up or a super top up plan.

Is it necessary to buy a top up plan from the same company? No, if you have a health insurance policy let’s say with ICICI Lombard, you may buy a top up or super top up plan with United India Insurance.

Why are top up or super top up plans cheap? The deductible limit makes these plans cheaper when compared to regular plans. Higher the deductible (threshold limit), lower the premiums of top up plans. Generally, Top up plans are cheaper than super top up plans.

Can I Top up a family floater policy? Yes, Top-up policies come as individual and floater plans.

No Claim Bonus (NCB) & Top up plans – If you have accumulated no claim bonus (for claim free years), top up / super top up plans will pay the claim amounts over and above the regular plan’s sum assured + No claim bonus amount.

Top up plans generally do not offer No-Claim Bonuses.

Another important point is that most of the Top-up / Super Top plans work on reimbursement basis. They will pay the claim amount after the insurer gets the details of all the medical bills, to assess whether the policyholder has paid the deductible limit by himself or through any existing health insurance policy.

Are there any Top up plans for Parents / Senior Citizens? – Yes, some companies do offer top up plans for senior citizens. Example : United India Super Top up Plan.

Are there any income tax benefits on Top up plans? – Yes, the premiums paid on top up or super top up plans are eligible for Income Tax deductions under Section 80 D.

What are the important things that I should watch out for, before buying a Top up plan? – It is advisable to go through the policy wordings of any health insurance plan. Understand the important points like the duration for pre-existing diseases, scope of cover, if day-care procedures are covered, cover for pre & post-hospitalization expenses etc., (If you have an existing health insurance policy with a continuous cover for last say 4/5 years, some health insurance companies waive off pre-existing diseases condition)

My Opinion :

Should you top up your health cover?

As health expenses increase, you may find that your base health insurance is no longer sufficient for your needs. A serious illness or accident can require long term care and complicated treatment, that can quickly become expensive and exhaust your health cover.

If you think that the sum assured of your existing health insurance plan (personal or employer’s group mediclaim) does not suffice for expenses due to illness or accidents, you may definitely consider buying a top up or super top up health insurance plan.

Before choosing an additional cover, compare the premiums of additional regular policies, top up plans and super top up plans. Do not buy Top up health insurance plans just because they are cheap, they may not serve the purpose (as mentioned above). Super Top up Plans can be the best way to enhance your total Sum Assured. Always, keep in mind about the medical inflation before finalizing the required sum assured.

In case your basic policy and the top-up policy are from two different companies, informing two insurers and getting the claim settled may be cumbersome. So, you may consider taking a top up or super top up plan from the same company (not mandatory).

To summarize;

Top up / Super top up health insurance plans are cheaper than regular mediclaim policies.

You can buy them to enhance the basic sum assured.

Top up plans are beneficial when the claim amounts are over and above the threshold limit.

If you have an employer’s mediclaim policy, consider buying a top up or super top up plan.

Secure yourself with Super top up cover and never worry about your medical expenses again.

Sreekanth Reddy

Sreekanth is the Man behind ReLakhs.com. He is an Independent Certified Financial Planner (CFP), engaged in blogging, financial counseling & property consultancy for the last 6 years through his firm ReLakhs Financial Services . He is not associated with any Financial product / service provider.
The main aim of his blog is to "help investors take informed financial decisions."

Comments

RAJsays:

November 30, 2016 at 9:59 pm

Dear Sreekanth,
this is a very nice article with very good explanation. One small doubt. When we make a claim from two different insurance companies, as both of them require original bills to be submitted. In such cases how we can get two original bills for these companies. Usually hospitals does not provide two original bills. ( In our hospital also we dont provide). In such cases how they honour the claim?
regards
RAJ

Dear Raj,
The policyholder has to inform both the insurance companies simultaneously regarding the claim. The first company that receives the original bills will share them with the other one. Also, advisable to save a copy of all the bills.

hi Mr Sreekanth Reddy,
your article is quite simple but covering all aspects of policy thus very useful for a layman like me.
i need your advice.
i am a 43 yrs old executive working in a PSU that almost fully covers me and my family for all type of diseases without any upper limit and provides cashless facilities with MOU hospitals and the bills amount is also unknown to the employee.However an employee has to bear some cost of non-refundable things and partial payment of medical tests.So
1.Should I go for regular family floater plan?What would be the mechanism for interfacing between my employer’s facility and the insurer in such case?
2.Or Would you suggest me to go for a top up/super top up plan? If yes, then how my bill amount will be known to the insurers?
thanks in advance
Ranjan Sharma

I have check some super top up plan for my mother from apollo , religare and L&T, however when I have check the cost of these plans, their price are too steep and if When I have compared super top against policy with higher sum insured cover, there was no difference .
my mother age is 60 as of now.
I am bit confused to go with smaller cover and then super top up it or buy the policy with higher sum insured.
Could you suggest.

dear Srikanth ,
My fathers age is 62(retd. state govt employee) and mothers age is 56 both are covered under State Govt Employees Pensioners Health Cards ,both are healthy at the moment no bp or sugar , iam confused wether to take any meidcalim policy or top up since they are already covered under NTR health plan however the wordings of the plan are (In AP, Medical Expenses Limit is Rs2,00,000. However, in the cases where the cost of treatment exceeds Rs.2.00 lakhs, cashless treatment will continue. No network hospital shall deny the treatment in such cases.) so please advice me whether that would be sufficient or take a new plan to cover extensively ,if so please advice me
thanks and regards
Anil

Dear Anil ..Whether the amount is sufficient or not, it is very tough to say and predict, am I right?
We all know that one requires lakhs of rupees for any major surgery or treatment if any unforeseen things happens.
You may consider buying at least a Super Top-up plan (floater) for them.

The policy wording for New India Top Up Mediclaim says the following…
“This policy will respond only when the aggregate of all Hospitalisation expenses (except Pre / Post hospitalization expenses) of one or all members of the policy, exceeds the “Threshold” stated in the policy.”

My mother is 56 years old. since 3 years we have a Oriental Happy family floater policy. Now her office is providing corporate health care policy of 3Lakhs for their employees. Now i am planning to remove her name from oriental happy family floater since the premium is coming to 25000/- and take super top up plan for her. What insurance companies do you recommed for super top-up plans. She has hyper thyroid problem.
My one more doubt is , how to get cashless treatment if the hospital bill is more than 3Lakhs. And one more doubt is how to claim above 3 lakhs hospital bill. since, all original bills will be submitted to New India insurance for cashless treatment. What to submit to the super topup policy insurance claims department?. please reply me in detail.

Dear Mahesh,
Ideally it is not prudent to include senior or parents in family floater policy if the age gaps is on a higher side. Because the premium on floater policy is based on the senior member’s age.
May I know her retirement age? Will the corporate group cover be continued even if after her retirement?

You have to take photocopies of all bills and can get Claims settlement summary from insurer X (New India). These bills will need to get attested by the hospital and you can submit the attested photocopies along with the claims settlement summary to insurer Y (Top up). Insurer Y will then pay the remainder.

I recently bought a Super Top Up from L&T, they declined my policy stating they don’t cover Non Alcoholic fatty liver i has in 2013, my recent medical reports being crystal clear and recently have purchased a life insurance

Dear Faraaz..Based on their underwriting rules they would have declined. Did you mention about the medical condition (past data) in the proposal form? Suggest you to contact a different non-life insurance company.
Read: Best portals to compare Health plans.

I’m looking for an extended/top-up Health Insurance plans for dependents (Mother) heart surgery.
Currently I hold a policy of Rs 3,00,000 and cannot be claimed completely as there is a cap limit for each procedure i.e. in my case its only Rs 1,50,000.
Estimated cost of surgery would be around Rs 3,00,000 to Rs 5,00,000.

I have already enquired with HDFC ERGO, United Insurance for top ups plans but they said:
1. One cannot claim half amount from existing plan and remaining from top up plan.
2. Complete limit of existing policy should be exhausted. But we have cps limits for each procedure.

It would be great if anyone could advise some tips with respect to managing funds efficiently (i.e. any top up plans without restriction on above mentioned points or some efficient way that you have cracked)
Any immediate help on this is much appreciated.

I am working in a Central Govt PSU and covered with Employers Medical Benefit. Though there is no upper limit of SA but the hospitalization expenses are paid as per CGHS(Central Govt Health Scheme) rate. Presently I am posted in Kolkata and there are few Cashless Hospitals here. Many (though not all)of the Hospitals are empanelled under the employer and medical bills are re-imbursed after treatment as per CGHS rate.
My question is Do I need to take any Mediclaim/Health Insurance Policy? If yes, what SA should I take.
(In recent check I found my BP is 151/87 & Pulse rate is 101)

Dear Srikanth
I have posted my query to know why do I need additional Health Insurance when I am being provided Medical Benifit by Central Govt till my entire life (even after my retirement) free of cost.
Would you please mind to explain the neccessacity (pros ) of taking independent policy?

Dear Indrajeet..You have not mentioned about the cover being applicable even during your retirement. Also, if there is no upper limit and you can afford to bear the expenses from your pocket and then reclaim later, you may consider not to buy an additional plan.
What about your family members? Are they covered under the same plan?

Dear Sir,
I am 43 years old (businessmen) with a Mediclaim policy of 7 Lacs from National Insurance Co.
Now I wish to take Mediclaim policy for My wife-43 years, Son-18.5 years and Daughter-17.6years.
should I buy a Family Floater for all of 6Lacs and then take a Super Top up plan. Or shall I take a Super Top up plan for 15Lacs, with some threshold limit (say 50 thousand)?
Kindly suggest that what shall I do, please.

As per my understanding, Max Bupa Health Companion is one of the best Super Top-up policy available currently. It sounds strange. But surprisingly, this plan from Max Bupa is unique since it can be taken both as a base plan or Super top-up plan. The added advantage here is that the deductible can be removed in future to covert the plan to a base policy. Also, unlike normal Top-up or Super Top-up plans, this policy provides No Claim Bonus.
Do you have any feedback about this?

Dear RV,
Super top up plan can be taken without having any regular plan.
After retirement, if opne deos not have a regular plan then up to the deductible amount he/she has to bear the expenses from his own pocket.

Dear , my parents have a claim free family policy of Rs 5 lacs from NICL named BOI SWASTHYA BIMA since last 7 yrs .
My father is aug 1952 born and my mother is aug 1956 born . Now i wamt to buy a top up or super top up plan of Rs 10 lacs .Kindly suggest me the best plan which could adjust with my basic policy .

Thanks for providing so much useful information. Hope you are doing great. I have a Mediclaim of Rs. 5L with Apollo Munich and now looking for a Super top-up of Rs 20L, I have shortlisted L&T Super topup .. is it a good option? Any other option you can suggest.

Last year I bought star health insurance policy for my parents aged 67 and 66 respectively with a cover of 2 lakh each. I need to renew the policy now but I have read very bad reviews about their claim settlement.

Please suggest if I should renew the policy or buy new policy from some other vendor.

Also please suggest if I should buy super top up policy or increase the coverage amount as 2 lakh seems to be really less in today’s time.

Dear Vibhuti,
As long as you have disclosed all the details in proposal form honestly, the company has to honor claims (if any).
However, if you are not happy with them, you may PORT the existing policy to another non-life insurance company (do not let it lapse).
Super top-up is very much beneficial, do consider it.

Thanks sreekanth for the prompt reply. Please suggest any other company which provides good insurance for senior citizens.
Also please suggest whether I should increase the sum assured or get a super top up plan in addition to the current policy of 2 lakhs.

A very good afternoon to you and all our blog readers!
As I said earlier, I have purchased
1) Online term insurance, “HDFC Click2 Protect Plus” for 55 lacs,
2) Stand alone Personal accident policy for 50 lacs from “Apollo Munich”
3) Super top up mediclaim policy for 10 lacs with 1 lac deductible from “Apollo Munich” beside my company’s group medicliam policy for 2 lacs.

I would like to share my experience with the Companies while purchasing the policies, so that it will be useful for other readers.
1) Apollo Munich’s services are very very good, with one single personal meet at my home, just within 7 working days, I have received Policy document in hand both soft copy by email and hard copy by post. and
2) HDFC Life Insurance company, for my term life insurance, they have taken 45 days to issue a policy though it was purchased “ONLINE”. For each and every email communication, they took 3-5 working days to respond, acknowledge or confirmation whatever the communication is.
As I am 41 years old, as I mentioned “Hypothyroid and heavy snoring” in my proposal form, they have advised me to undergo medical checkup at their prescribed diagnostic centre, I have under gone. Further, they have loaded me with 90% extra premium.
Even, they have reduced my sum assured amount from 75 lacs to 55 lacs.
My over all experience with HDFC is “Very good” though it is delayed and loaded with extra premium, but they have taken all required steps, so that, I believe, when ever claim is required, my family members may not face any difficulty in claiming process.
Dear Sreekanth, Thank you for your advises through your blog, which were helpful for so many lakhs of people like me while taking such big decisions.
I would like to post the same info in your 2 – 3 relevant articles, which will be helpful for all other readers.
It is good to see that you have relocated to Proddatur, so when I visit my native place Kadapa, with your prior confirmation I would like to see you.
Thank you
Krishna KP

Dear Krishna,
I am very happy to know that ReLakhs.com helped you in making financial decisions 🙂
Thank you so much for sharing your real-life experiences with the financial service companies.
Which option under HDFC Click2protect plus did you take?
By the by, we can surely plan to meet 🙂

Are there any health policies which offer policy or top up for existing diseases .( cancer). They say that pre existing conditions are covered after a specified period (4 years or less) .but will they offer policy even for extra premium.If so please inform

My parents have a 5 lacs sum insured family floater policy from National Insurance (Parivar Mediclaim). My father is 58 years old and mother 52 years. Its a claim free policy since last 7 years. However, there is a limitation to the policy which allowes only 50% S.I as the maximum amount for one claim which limits the coverage to 2.5 lacs for my mother and father each.

Additionally i have a family floater plan from my employer covering my parents for 5 lacs. I am trying to buy a Super Top Up Plan for 15 lacs with a 5 lacs deductible limit. However, there is a condition that my father suffers from Hypertension (BP) and is on a regular medication. Moreover, he had an Angioplasty way back in 1998 and since then he is leading a normal healthy life. As he has crossed 55 years age, most companies want medical tests to be conducted. But, as we know his reports (ECG) specially doesnt come out to be perfect because of the angioplasty done in 1998. I am afraid, if we propose to buy a Super Top Up policy, this would be a big issue for my father to get coverage.

Otherwise, i had selected L&T’s and Religare’s Super Top Up Plan. Can you advice on this case. Many thanks.

I have a family floater policy of SI Four Lakhs. after the age of 55 as per the policy norms 20% co- pay for all hospitalizations upto 80 years. It means if a medical bill is 4 lakhs and 20% co pay 80,000/- I have to pay from my own pocket
So if I buy United india health super top up policy , that ratio is 3 rest to 5 and 7 lakhs
It means united india will pay that amount or i have to pay

i found the artcle very useful. thanks. we are 3 seniors , self 75, wife 69 and motherin law 86! i am porting from National healths varishta to united india. because:
varishta in critical illness component (CIC) does not cover angioplasty, as per the policy. in small print it also says for bypass limit is 20% of insured amount ie rs 60000. and when one gets hospitalised for other than CIC, the max cover is Rs one lakh. it cannot be increased. i think the policy is a real rip off for seniors.
please advice on this matter: when we took varishta 7 years back we had no BP. now with age it is there though under treatment. if asked by united, is it better to declare BP and pay higher premium. if so will there be a period where they will not cover BP related surgeries like angioplasty or by pass?

very informative article. thanks for the same. we are family of 3, self 75, wife 69, mother-in-law 86! i am shifting from national insurances varishta mediclaim to united india insurance, because:
varishta’ s critical illness component does not cover angioplasty (as mentioned in the policy). it covers by pass surgery but limit is 20% of insured amount. i guess this limits the expenses paid to rs 60000, which is a measly amount.
other than critical illness component, cover is max rs 1 lakh. so if one gets hospitalised due to other than critical illness, what one gets is peanuts. i think the policy is a rip off for seniors.
please advice on this matter- when we took varishta about 7 years back we did not have BP. now when i port the policy to united, is it better to declare the BP which has come with advancing age and under medication, and pay additional premium if asked ?

I am 24 years old and I have a floater policy (Group Policy) from Company’s side (Of UIIC-Tailor made policy). Sum Assured is Rs. 4 lacs. I have a younger sister who is 20 years old. My parents are 51 years old. I want to provide my family a larger cover, with minimum premium possible due to financial burdens. Keeping in view the age constraints and the situation in which after marriage, they no longer be covered, Please suggest a good policy such that they are covered for maximum possible tenure. Please help. Thank you so much.

Pl refer to your reply dated July 15,2015 to a query by Mr Anurag Kalra. His query was that if he has a base plan cover of Rs. 3 lacs and if he buys an additional super top plan of United Insurance, then whether the total c over available to him would be 3+7=10 lacs or 3+4=7 lacs. You have mentioned 7 lacs. I believe your reply requires more elaboration else it is confusing. I believe that the Total cover available to Mr Anurag would be 10 lacs [3 from base policy and 7 from super top us] ;whereas the liability of United Insurance would be limited to 7 lacs beyond expenses of 3 lacs. Please confirm if I am correct or not. Example : if the bill is 11 lacs. 3 lacs would come from the base policy. 7 Lacs from supertop up and 1 lac from his own sources

If Your Are Looking Good Health Insurance Policy , You can Go for , iffco tokio`s Skp, and Health Protector Series, competitive Rate and Good Penetration of Company`s Representative and Service Offices .

Under super top up policy issued by UIICL, my wife was operated for her bilateral knee replacement surgery, after 4 days of hospitalization she was discharged; she had physio-therapy treatment from a registered qualified Dr. Physio Therapist for 60 days (since the surgery was for both the legs). Is physio therapy treatment payable ? The policy conditions provide (clause 5.4) that “IN CASE OF POST -HOSPITALIZATION, TREATMENT (LIMITED TO 60 DAYS), ALL CLAIM DOCUMENTS SHOULD BE SUBMITTED WITHIN 15 DAYS AFTER COMPLETION OF SUCH TREATMENT” Pl advise.

2. Can we combine 2 policies. For example if I have one policy of 3 lacs and it gets exhausted and I have another policy of 2 lacs. Can two different policies be used for one treatment in continuation.

Hi, I am trying to understand these concepts and this article explains what I am looking for. I still have few queries to clarify. Let’s consider the same example as above where the person has 3 Lakhs base cover and 7 Lakhs top up cover. Let’s assume this as scenario 10. What if there are multiple claims in a year with claim1 – 3 Lakhs and claim2 – 4 Lakhs ? I understand the first claim will be paid by the base policy and it will be exhausted. For claim 2, will the topup plan pay the entire 4 Lakhs or just 1 lakh after deducting the threshold limit from the claim??

Scenario 11- what if the first claim is for 2 Lakhs and he still has 1 lakh left in the base cover and he has a second claim for 4 Lakhs in the same year? How much will the topup insurance provider pay?

Dear Sabari,
Scenario 10 – Claim 2 will be covered under Top up plan as it is above the Threshold limit of Rs 3 Lakh.
Scenario 11 – Calim 1 will be paid by regular plan and Rs 4 lakh (claim 2) will be serviced by top up plan.

Dear Shankha,
Kindly note that it is highly impossible to fine the best health insurance plan.
Each plan has its own merits & de-merits. So, kindly opt for a plan which meets most of your requirements.

Dear Shankha,
For example – You may Rs 5 L policy, but if there is a sub limit for room rent say maximum allowed is Rs1k per day, you can not claim charges under room rent beyond Rs1k.
Regarding co-pay clause, the policyholder has to pay certain agreed portion of claim amount, this can be say 80:20,in this case 20% of claim amount should be paid by the policyholder and the remaining 80% will be borne by the insurance company.

But I have to do M. Insurence personally as I am working in private sector.

As per my convenience, (Age 34 ) I can took Rs 5 L SA .

1) Should I buy Super -Top-up with this 5 L SA?
2) What will be the good amout for Super -topto with 5 L SA?

3) If I buy 5 L SA from New India and Super -top-up from United India , How the claim will be done when we go for Super -top-up ? Beacuse all original documents needs to be submitted to the 5 L SA claim.

Dear Shankha,
It is a good decision to buy an independent medical insurance cover. Go ahead!
Suggest you to buy a regular health plan first for Rs 5 Lakh and then may be a year after you can buy a Super Top up plan with a deductible of Rs 5L or Rs 13L .
The policyholder has to inform both the insurance companies simultaneously regarding the claim. The first company that receives the original bills will share them with the other one.

Firstly I wanted to thank you for the useful information you have posted.

My son had leukemia last year, I did the treatment thru my company’s insurance(3 lacs). The total hospital charges costed me around 11laks. Now I am planning to take my personal Family Floater plan for 5 lacs (independent plan) and also take a family floater super top up plan for 10 lacs from United India.

By God grace…My son is doing good… He is into the maintenance cycle and he is going to Montessori. Secondly I wanted to ask your suggestion. I am planning to take up the family floater from Untied India. But how about the TPA service. Can I opt for Vidal Health which was formerly know as TTK. Which TPA service is good so that we don’t find any issue in the claims in the future… if in case touchwood.

Recently I enquired with one of insurance advisor (Maxbupa) regarding the Health insurance policy which I had early discussed with you. He confirmed that there are no insurance companies which will cover pre-existing disease i.e. for leukemia. I am bit tensed and worried when I heard about this. I am currently not able to think properly about my son future regarding with his health insurance. Do you know any insurance company which can cover my son pre existing disease converge.

Dear Dinesh,
Your advisor can be right. Suggest you to check out with all major health insurance companies about this. Insurance company can cover the risk after initial waiting period for the pre-existing disease.
Kindly check out L&T insurance’s MY Health Medisure Classic plan, I believe it covers Leukemia, but has 3 year waiting period.

Dear Gupta,
You may consider United India’s Super top-up plan. I have provided the link in the article itself.
You may also read my article – “Health insurance plans for Parents / Senior citizens“.(Do mention about mother’s hypertensive thing in proposal form)

a) Suppose mu parents make 2 claims in a year – 3 lacs and 7 lacs. Then will the super top plan reimburse the additional (7+3 – 5) = 5 lacs or it has to be a single claim ?
b) Any sub limits on different operations here in govt super top up plans?

One query regarding the claim process when you have a top up plan along with regular mediclaim policy…

Scenario: I have 3 L (Regular Cashless) + 10 L (Top Up).
Now suppose the toal bill for hospitalization is 6 Lakhs. My regular cashless policy will cover first 3 L of bill since it has tie up with hospital and the settlement of bills & documents will be done without hassles.
But for the rest of 3L bill how will I produce bills to top up insurer company, since the hospital will not issue me duplicate bills nor the top up company will entertain duplicate bills.
How does this work in such case?

Dear Pawan,
If it is a cashless scenario (planned hospitalization), you may have to inform both the insurance companies (so it makes sense to have both the plans from the same company but not mandatory though).
If it is a reimbursement scenario, depending on the claim amount, you need to follow up..

Hi Sreekanth,
I have 6L floater policy (3L basic + 3L additional top up) from UnitedHealthcare through my company.
Due to cancer medical treatment for my mother, we have claimed the full amount(6L) this year. we are left with zero medical cover now.
I want to take another health plan for this year.

What are the main difference from super top up plan (except premium rate) compared to basic medical plan..because when i enquired some waiting period and Deductibles rules are applied in super top up plan.. please share me your opinion..should i go for basic medical plan or super top up plan ?

Hi Srikanth,
Thanks for your help!.
She is getting better now. she is 60 now. my age is 31. and my wife age is 28.
Now i will (have to) spend other treatment expense from my hand for mother since no medical insurance company will accept her for top up plan now.
But i want to take another medical plan for me and my wife since we are left with zero cover now.
Kindly recommend a suitable medical plan.
[my company medical plan will be renewed in November]

Dear Jebastan,
Kindly buy a Regular Family Floater plan (covering self & spouse) immediately. Do not depend on employer’s group mediclaim alone.
Nest year or so, you may buy a Super-Top up plan with a deductible of say employer provided cover + new regular plan’s cover.

Dear Rajesh,
Suggest you to take personal Family Floater plan (independent plan) and consider taking a family floater super top up plan (may be with employer’s + this new plan coverage amount as deductible amount, the premium can be lower because of high deductible amount).

Hi Sreekanth, thats a good suggestion. But my company provider floater plan is having portable option so i can carry forward even if i leave company. Do you think i should still buy personal family floater.

More over there is only 200 to 300 difference in premium above 3 lakhs Deductible.

thanks for responding to my quires My last query is if i go for another individual family floater of 3 lakhs. is it mandatory to take super top with 6 lakhs deductibles or i can take 3 lakhs as per my wish?

Kindly suggest me the best Mediclaim policy for my parent (Mother – 63 age, Father – 64 age)
My mother has arthritis and high blood pressure, I wanted to cover pre-existing diseases.
My father do not have any diseases.
1. Should I go with Individual policy or Family Floater policy ?
2. Wanted insure for max upto 5 lac or more.
3. Also settlement ratio should be better.
4. Wanted to avoid pre-health check up (optional).